Does your gut need a reset?

Yes, I'm Ready

Do you want to start feeling better?

Yes, Where Do I Start?

Do you want to start feeling better?

Yes, Where Do I Start?
About
Learn
Shop
Work With Us
Podcast
Login
Shop Solutions
Articles
Evidence based

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Do Probiotics Cause Bloating, or Could it Be Something Else?

Written by on March 16, 2024

Teasing Out the Real Reason You’re Bloated on Probiotics and What to Do About It

Key Takeaways:

  • Probiotics have few, if any, side effects for most people, but you might avoid potential bloating by choosing a high-quality product without certain ingredients or additives.
  • If you have a particularly sensitive digestive system, trying a high-quality probiotic, one category at a time, may help prevent side effects, including bloating.
  • Probiotic foods are more likely to cause bloating than probiotic supplements due to their high quantity of histamines and other irritants.
  • Persistent bloating seems like a side effect of probiotics if you have unresolved issues like food intolerances, IBS, SIBO, stress, or faulty pelvic or abdominal muscles.
  • You can add science-backed diet changes, supplements, or other treatments to give your probiotics the best chance of relieving your bloating and other symptoms.

Have you noticed an increase in gas, bloating, cramping, or other gastrointestinal symptoms that started around the time you began adding probiotics to your daily routine? While probiotic supplements have a strong safety record (even at very high doses), you may be wondering if they’re to blame for your new symptoms.

It’s not entirely uncommon for people trying a new probiotic to have new symptoms like bloating. Usually, that’s just a sign that you’re adjusting to the changing gut bacteria, and it goes away in less than a week. But for some people, it doesn’t work out so smoothly. In our clinic, probiotics are central to treating patients with an array of symptoms, which means I’ve had a lot of experience helping people troubleshoot their probiotic regimens. 

So, why do some people get bloated after starting probiotics? In general, some probiotics are derived from common allergens, like dairy and egg, which could be responsible for your bloating. Also, many probiotic formulas contain prebiotics, which could be irritating to your system, especially if you have small intestinal bacterial overgrowth (SIBO).

To ensure that you’re maximizing the health benefits of probiotics and minimizing potential side effects, you’ll want to pay attention to the ingredients. Just as important is to make sure you’re buying a good-quality product from a reputable supplement company.

Now let’s look more closely at why you might be bloated after starting a new probiotic regimen. I’ll also guide you on how to avoid bloating, whether or not your probiotic is to blame, and the best ways to safely and smoothly incorporate probiotics into your diet.

Probiotic Bacteria Are Not Likely to Cause Bloating

Though this might seem counterintuitive, it’s highly unlikely that the healthy bacteria in a probiotic formula are to blame for your bloating or other digestive issues [1, 2]. In fact, a large body of quality research has found that probiotics actually relieve bloating better than placebos do, especially for people with irritable bowel syndrome (IBS) [3, 4, 5, 6, 7, 8, 9, 10]. That said, some people are very sensitive to probiotics and may have temporary discomfort as they adjust to them. And sometimes probiotic supplements contain more than just bacteria.

Probiotics are generally considered safe, but like any dietary supplement, quality assurance and the particular ingredients matter. If you experience flatulence, constipation, or changes in bowel movements when introducing a new probiotic formula, it’s possible that the one you’ve chosen isn’t right for you. There are a few ways I’d recommend proceeding if this is the case.

First, Check for Allergens

To make probiotics, manufacturers first create a substrate that provides the nourishment probiotic bacteria (and sometimes fungi) need to grow. Then, they add probiotic strains and wait for them to ferment and multiply. Once they have the desired number of colony-forming units (CFUs), they separate out the probiotic bacteria, use various methods to make them shelf-stable, blend them with other strains if needed, and bottle them up.

Sometimes the initial substrate contains potential irritants like egg or dairy. If you have an allergy or sensitivity to eggs or dairy, then you will want to make sure your probiotic formula is completely egg- and dairy-free [1, 2]. Most probiotics will also highlight that they’re gluten-free, but that’s pretty standard—I’ve never seen a probiotic formula that contains gluten.

Additionally, some supplement companies include excipients, such as fillers, preservatives, or colorants. Excipients should be inert, but some people may react to certain kinds. Some probiotics, especially gummies, also contain flavorings, so be aware of flavoring ingredients when choosing your formula. In general, make sure your product says it’s allergen-free.

Second, Look for Prebiotic Dose

Prebiotics are fibers often included in probiotic formulas that are technically called synbiotics, with the prefix “syn” meaning together. Many healthy foods you regularly eat contain prebiotic fibers, but some people have a hard time digesting them. You might be hard-pressed to find a formula that contains zero prebiotics, so shoot for one that has no more than 3–5 grams per daily serving [11, 12, 13]. 

Third, Ensure Good Quality

Admittedly, it’s hard to know who to trust when it comes to supplements because they aren’t regulated by the Food and Drug Administration (FDA). However, the most reputable supplement companies will have a GMP (Good Manufacturing Practice) stamp indicating their products are consistently of high quality. They will also engage in third-party testing to ensure unbiased quality control. 

When shopping for a probiotic, look for a GMP stamp and a seal from one of the following:

  • National Sanitation Foundation (NSF)
  • The US Pharmacopeia (USP)
  • Consumer Labs (CL)

You can also subscribe to ConsumerLab.com to find out which products they list as safe.

Fourth, Eliminate All But One

If you’re taking multiple categories of probiotics like I recommend in my triple-therapy approach, it’s possible that one of them doesn’t agree with you yet. Taking out two categories to see how you do with one at a time doesn’t have a lot of research behind it. However, the principles of elimination diets and my clinical experience support the idea of trying to isolate what is creating the side effects you’re experiencing. The idea is to start slowly with a low dose of one category and slowly add the others, one by one, to let your body acclimate.There are three categories of probiotics. Category 1 consists of a blend of Lactobacillus and Bifidobacterium species. Category 2 is a healthy yeast called Saccharomyces boulardii, and category 3 is a soil-based probiotic containing various species of Bacillus.

Probiotics causing bloating

Start off with half a recommended dose of Category 1, the most widely available type of probiotic. Using your symptoms as your guide, slowly work your way up to the full dose (10 billion CFU) and stay on that for 2–3 months. However, if you’ve chosen a high-quality, allergen-free, low-prebiotic formula and still have symptoms like bloating after 1 month, your body may not be able to handle one or both of those strains of bacteria right now. 

If bloating persists, discontinue your Category 1 probiotic and move on to a half dose of a different probiotic, one from Category 2. Again, work your way up and stay on the recommended dose (10–15 billion CFU) for 2–3 months. If you still have bloating or other GI symptoms, discontinue and do the same with Category 3 until you reach 2–6 billion CFU.

Probiotics causing bloating

In my many years of experience, I’ve never had a patient who couldn’t tolerate at least one category. Ultimately, as you continue on your gut health journey and begin to heal, you may find that you can reintroduce one or both of the other categories with no side effects.

Die-Off Symptoms

It’s unlikely that die-off reactions would include bloating, but I want to mention them here just in case you experience some of the more common die-off symptoms. 

Also called a Herxheimer reaction, a die-off reaction occurs when you take something (like antibiotics, herbal antimicrobials, or even probiotics) that kills lots of bacteria in your gut. When the bacteria die, they release toxins into your bloodstream, which can set off your immune system. This creates symptoms as your body works to protect you from and get rid of the toxins [1, 2].

When assessing your own symptoms, it’s important to differentiate between temporary and long-term discomfort. Die-off symptoms typically include flu-like fatigue, headache, and brain fog, but none of them should last more than a week. If they do last longer, you’re probably dealing with something complex enough to bring to your healthcare provider. 

Probiotic Foods May Cause Bloating

Interestingly, while it’s unlikely that a probiotic supplement will cause bloating, it’s very possible that probiotic foods, like sauerkraut, kimchi, kombucha, or kefir, could. Bloating is typically associated with probiotic foods rather than probiotic supplements because these foods contain a few potential irritants, such as histamines, FODMAPs, and lactose [14, 15, 16, 17].

Histamines in Fermented Foods

Histamines are a byproduct of the fermentation process that turns fresh foods and juices into probiotic foods. In other words, there are more histamines in fermented foods than in other types of food.

Some people find extra histamines irritating, and some even have histamine intolerance. Histamine intolerance is when the digestive enzymes your body uses to break down histamine in foods aren’t working properly. As a result, histamine can build up and cause symptoms like bloating, nausea, rash, headache, and itching [18].

Since probiotics are made through a process of fermentation, it’s logical to think they contain histamines and could lead to reactions in sensitive people. It’s true that some probiotic strains do produce histamine, but these are not common in probiotic formulas, and we don’t yet know whether probiotics contain enough histamine to incite a reaction. 

Paradoxically, although we need human studies to conclude with any certainty, taking certain probiotic strains could theoretically help improve histamine intolerance [19]. In other words, continually using probiotic supplements may eventually allow you to tolerate fermented foods again in the future, after your digestive system has reset. This may be especially true if you follow a low-histamine diet, which I’ll explain soon.

FODMAPs in Fermented Foods

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are short-chain carbohydrates. The small intestine sometimes has a hard time digesting these types of sugars, leading to gas and bloating. This is especially problematic in people with SIBO, whose excessive bacteria in the small intestine make a lot of gas from FODMAPs. 

The most common high-FODMAP probiotic foods are coconut yogurt, dairy yogurt, sauerkraut, and kombucha. These foods (and drinks) contain indigestible carbohydrates that can lead to flatulence and bloating in some people. 

In particular, if you’re dealing with IBS or SIBO, you’ll want to stay away from high-FODMAP foods and lean into a low-FODMAP diet, which I’ll explain more in the next section. Not only will you give yourself a break from gas and bloating, you’ll also begin to kill off the excessive gut bacteria colonizing your small intestine, where they don’t belong.

Lactose in Fermented Foods

I mentioned dairy earlier in the context of supplements, but it’s worth repeating here as well. Dairy-based probiotic foods like yogurt and kefir may cause bloating if you have lactose intolerance.

How to Improve Persistent Bloating

Most likely, you’re taking probiotics to improve some sort of microbial imbalance in your gut that’s causing symptoms. You should expect it to take at least 1–2 months for your gut microbiome to shift and improve on probiotics. But if you continue to experience bloating after 1–2 months, you may need to give your probiotics a helping hand. 

For example, probiotics alone may not be able to fully take care of your bloating if you also have unresolved food intolerances [20, 21, 22, 23], IBS or SIBO [24, 25], stress [26, 27, 28, 29], or dysfunctional abdominal [30] or pelvic floor [31, 32, 33] muscles. The good news is that multiple treatments combined with probiotics can take a firm stand against bloating.

Diets for Bloating Related to Food Intolerances, IBS, or SIBO

  • Low-FODMAP Diet [34, 35, 36, 37, 38, 39] – This diet restricts certain carbohydrates, including those in foods like garlic, onions, stone fruits, and most cruciferous veggies (like broccoli and cabbage) that would otherwise fall into the “healthy food” category. Temporarily avoiding these foods will give your digestive system a break and begin starving out any excessive bacteria in your small intestine that may be the source of your bloating. Even if you don’t have an overgrowth of bacteria in your small intestine, you may have IBS that responds well to removing FODMAPs for a while. Start with this diet and move on to a low-histamine diet if the needle on your bloating doesn’t move.
  • Low-histamine diet [21] – If the low-FODMAP diet doesn’t cut it and you suspect you’re sensitive to high-histamine foods, such as aged cheeses, cured meats, chocolate, and fermented foods, try going low-histamine for about three weeks. If you notice less bloating and other symptoms, such as sniffling, sneezing, headaches, rashes, diarrhea, abdominal pain, or itching, you may have discovered a histamine intolerance. On the bright side, supporting your gut with probiotics could help you tolerate higher-histamine foods over time. But if neither the low-FODMAP nor low-histamine diet is quite enough for your bloating, you can try combining them. 

Whichever dietary route you take, make sure to start reintroducing foods as you feel better to get a full spectrum of nutrients and continually support your improving gut microbiome [40].

Here are some dietary add-ons that may amplify your relief from bloating:

  • Elemental Diet [41] – This may be used as a short-term temporary gut reset alongside any of these plans to help heal underlying issues (like SIBO) contributing to bloating.
  • Low-gluten diet [42] – A low-FODMAP diet is typically low in wheat and therefore gluten, but, when you’re on a low-histamine diet, eating less gluten may reduce bloating even more.
  • Intermittent Fasting [43] – Eating during an 8-hour window and giving your gut a rest for the other 16 hours a day (including the hours you’re sleeping) can accentuate reductions in bloating.
  • Reducing dietary fiber [44] – Fiber triggers bloating in some people. A low-FODMAP diet is typically low in fiber, but reducing your fiber may be a good addition to a low-histamine diet.

Supplements, Medications, and Herbs for Bloating Related to Sluggish Digestion, IBS, or SIBO

  • Digestive enzymes [45, 46, 47, 48] – Various enzymes may boost your digestive juices if they’re low, and potentially reduce bloating.
  • Peppermint oil [49, 50, 51, 52, 53, 54) – Peppermint can improve digestion in some people and may reduce bloating. But be careful: Peppermint can make reflux and heartburn worse [55].
  • Antibiotics like rifaximin [49, 56, 57, 58, 59) – This prescription medication can help probiotics eliminate SIBO that may contribute to your bloating.
  • Herbal antimicrobials like Iranian thyme [60] – These can help probiotics eliminate SIBO or other imbalances in gut microbes that could contribute to bloating. 

Stress-Reduction Techniques for Bloating

  • Gut-directed hypnotherapy [61, 62, 63, 64, 65] – With the help of a trained therapist, this can effectively reduce IBS symptoms, including bloating.
  • Cognitive-behavioral therapy [61, 62, 63, 66, 67] – A trained CBT therapist can help you get relief from IBS symptoms like bloating.
  • Meditation [68, 69, 70, 71, 72, 73] – Meditation practices like mindfulness-based stress reduction can calm stress and related bloating.
  • Yoga [74] – Yoga may be good for reducing IBS symptoms such as bloating.
  • Walking [75] – Walking after meals may be a good way to reduce stress and put a dent in abdominal bloating.

Biofeedback Options for Bloating Related to Muscular Dysfunction of the Abdomen or Pelvis 

  • Abdominal biofeedback [69, 76, 77] – You’ll need a skilled practitioner to get started, but breathing-focused biofeedback can reduce bloating.
  • Pelvic floor biofeedback [32, 78] – With help, learning to reduce the effort you put into pooping can help relieve bloating. 

To simplify this long list of action items to help with persistent bloating, I recommend that, with a clinician’s support, you start by adding to your probiotics a low-FODMAP diet and 10–15 minute walks after meals. The low-FODMAP diet can improve symptoms like bloating by reducing inflammation and starving out bad bacteria living in your small intestine [79]. And walking is a no-cost, no-equipment intervention that can improve bloating, belching, flatulence, feelings of over-fullness, and abdominal discomfort [75].

Start there and see how you feel. Keep track of changes in your bloating and other digestive symptoms, and see what has changed after several weeks. The other science-based options are available for you to try if you need a boost, and make sure to check out anything new you try with your healthcare provider.

You Can Navigate Bloating While Taking Probiotics

The relationship between probiotics and bloating is nuanced. While probiotics offer a myriad of potential benefits for the gut microbiome, some people experience digestive symptoms, like bloating, while taking them.

Potential reasons for a digestive reaction may reside inside the bottle of probiotics or within your digestive tract. To deal with potential probiotic product issues, make sure to avoid untested formulas with common allergens like dairy or egg, unnecessary fillers, flavors, or colorants, and more than 3–5 grams of prebiotics.

To address issues with your digestive system, you might add a low-FODMAP diet and short walks after meals, and experiment with other gut-supportive treatments if necessary.

Understanding the factors that may contribute to your bloating and implementing practical strategies can empower you to troubleshoot and improve your digestive health over time. And if you’re looking for extra guidance and support, we’re here to help. Feel free to reach out to our clinic to set up a consultation to get started.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.
➕ References
  1. Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi P. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018 Nov;48(10):1044–60. DOI: 10.1111/apt.15001. PMID: 30294792.
  2. Hungin APS, Mitchell CR, Whorwell P, Mulligan C, Cole O, Agréus L, et al. Systematic review: probiotics in the management of lower gastrointestinal symptoms – an updated evidence-based international consensus. Aliment Pharmacol Ther. 2018 Apr;47(8):1054–70. DOI: 10.1111/apt.14539. PMID: 29460487. PMCID: PMC5900870.
  3. Xie P, Luo M, Deng X, Fan J, Xiong L. Outcome-Specific Efficacy of Different Probiotic Strains and Mixtures in Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis. Nutrients. 2023 Sep 4;15(17). DOI: 10.3390/nu15173856. PMID: 37686889. PMCID: PMC10490209.
  4. Ford AC, Quigley EMM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547–61; quiz 1546, 1562. DOI: 10.1038/ajg.2014.202. PMID: 25070051.
  5. Yuan F, Ni H, Asche CV, Kim M, Walayat S, Ren J. Efficacy of Bifidobacterium infantis 35624 in patients with irritable bowel syndrome: a meta-analysis. Curr Med Res Opin. 2017 Jul;33(7):1191–7. DOI: 10.1080/03007995.2017.1292230. PMID: 28166427.
  6. Tiequn B, Guanqun C, Shuo Z. Therapeutic effects of Lactobacillus in treating irritable bowel syndrome: a meta-analysis. Intern Med. 2015;54(3):243–9. DOI: 10.2169/internalmedicine.54.2710. PMID: 25748731.
  7. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008 May 7;14(17):2650–61. DOI: 10.3748/wjg.14.2650. PMID: 18461650. PMCID: PMC2709042.
  8. Ishaque SM, Khosruzzaman SM, Ahmed DS, Sah MP. A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult®) in the management of diarrhea-predominant irritable bowel syndrome. BMC Gastroenterol. 2018 May 25;18(1):71. DOI: 10.1186/s12876-018-0788-9. PMID: 29801486. PMCID: PMC5970461.
  9. Sun Y-Y, Li M, Li Y-Y, Li L-X, Zhai W-Z, Wang P, et al. The effect of Clostridium butyricum on symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. Sci Rep. 2018 Feb 14;8(1):2964. DOI: 10.1038/s41598-018-21241-z. PMID: 29445178. PMCID: PMC5813237.
  10. Whelan K. Probiotics and prebiotics in the management of irritable bowel syndrome:  a review of recent clinical trials and systematic reviews. Curr Opin Clin Nutr Metab Care. 2011 Nov;14(6):581–7. DOI: 10.1097/MCO.0b013e32834b8082. PMID: 21892075.
  11. Wilson B, Rossi M, Dimidi E, Whelan K. Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2019 Apr 1;109(4):1098–111. DOI: 10.1093/ajcn/nqy376. PMID: 30949662.
  12. Asha MZ, Khalil SFH. Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis. Sultan Qaboos Univ Med J. 2020 Feb;20(1):e13–24. DOI: 10.18295/squmj.2020.20.01.003. PMID: 32190365. PMCID: PMC7065695.
  13. Whelan K. Mechanisms and effectiveness of prebiotics in modifying the gastrointestinal microbiota for the management of digestive disorders. Proc Nutr Soc. 2013 Aug;72(3):288–98. DOI: 10.1017/S0029665113001262. PMID: 23680358.
  14. Parker EC, Gossard CM, Dolan KE, Finley HJ, Burns CM, Gasta MG, et al. Probiotics and Disease: A Comprehensive Summary-Part 2, Commercially Produced Cultured and Fermented Foods Commonly Available in the United States. Integr Med (Encinitas). 2016 Dec;15(6):22–30. PMID: 28223894. PMCID: PMC5312833.
  15. Bibiloni R, Fedorak RN, Tannock GW, Madsen KL, Gionchetti P, Campieri M, et al. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol. 2005 Jul;100(7):1539–46. DOI: 10.1111/j.1572-0241.2005.41794.x. PMID: 15984978.
  16. Gionchetti P, Rizzello F, Morselli C, Poggioli G, Tambasco R, Calabrese C, et al. High-dose probiotics for the treatment of active pouchitis. Dis Colon Rectum. 2007 Dec;50(12):2075–82; discussion 2082. DOI: 10.1007/s10350-007-9068-4. PMID: 17934776.
  17. Larsen CN, Nielsen S, Kaestel P, Brockmann E, Bennedsen M, Christensen HR, et al. Dose-response study of probiotic bacteria Bifidobacterium animalis subsp lactis BB-12 and Lactobacillus paracasei subsp paracasei CRL-341 in healthy young adults. Eur J Clin Nutr. 2006 Nov;60(11):1284–93. DOI: 10.1038/sj.ejcn.1602450. PMID: 16721394.
  18. Schnedl WJ, Enko D. Histamine intolerance originates in the gut. Nutrients. 2021 Apr 12;13(4). DOI: 10.3390/nu13041262. PMID: 33921522. PMCID: PMC8069563.
  19. Hrubisko M, Danis R, Huorka M, Wawruch M. Histamine Intolerance-The More We Know the Less We Know. A Review. Nutrients. 2021 Jun 29;13(7). DOI: 10.3390/nu13072228. PMID: 34209583. PMCID: PMC8308327.
  20. Schnedl WJ, Lackner S, Enko D, Schenk M, Holasek SJ, Mangge H. Evaluation of symptoms and symptom combinations in histamine intolerance. Intest Res. 2019 Jul;17(3):427–33. DOI: 10.5217/ir.2018.00152. PMID: 30836736. PMCID: PMC6667364.
  21. Enko D, Meinitzer A, Mangge H, Kriegshäuser G, Halwachs-Baumann G, Reininghaus EZ, et al. Concomitant prevalence of low serum diamine oxidase activity and carbohydrate malabsorption. Can J Gastroenterol Hepatol. 2016 Nov 30;2016:4893501. DOI: 10.1155/2016/4893501. PMID: 28042564. PMCID: PMC5155086.
  22. Croall ID, Hoggard N, Aziz I, Hadjivassiliou M, Sanders DS. Brain fog and non-coeliac gluten sensitivity: Proof of concept brain MRI pilot study. PLoS ONE. 2020 Aug 28;15(8):e0238283. DOI: 10.1371/journal.pone.0238283. PMID: 32857796. PMCID: PMC7454984.
  23. Dieterich W, Zopf Y. Gluten and FODMAPS-Sense of a Restriction/When Is Restriction Necessary? Nutrients. 2019 Aug 20;11(8). DOI: 10.3390/nu11081957. PMID: 31434299. PMCID: PMC6723650.
  24. Amieva-Balmori M, Coss-Adame E, Rao NS, Dávalos-Pantoja BM, Rao SSC. Diagnostic utility of carbohydrate breath tests for SIBO, fructose, and lactose intolerance. Dig Dis Sci. 2020 May;65(5):1405–13. DOI: 10.1007/s10620-019-05889-9. PMID: 31617133.
  25. Houghton LA, Lea R, Agrawal A, Reilly B, Whorwell PJ. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology. 2006 Oct;131(4):1003–10. DOI: 10.1053/j.gastro.2006.07.015. PMID: 17030170.
  26. Roohafza H, Bidaki EZ, Hasanzadeh-Keshteli A, Daghaghzade H, Afshar H, Adibi P. Anxiety, depression and distress among irritable bowel syndrome and their subtypes: An epidemiological population based study. Adv Biomed Res. 2016 Nov 28;5:183. DOI: 10.4103/2277-9175.190938. PMID: 28028523. PMCID: PMC5156966.
  27. Chen H-H, Hung C-H, Kao A-W, Hsieh H-F. Exploring Quality of Life, Stress, and Risk Factors Associated with Irritable Bowel Syndrome for Female University Students in Taiwan. Int J Environ Res Public Health. 2021 Apr 7;18(8). DOI: 10.3390/ijerph18083888. PMID: 33917268. PMCID: PMC8068066.
  28. Foster JA, Rinaman L, Cryan JF. Stress & the gut-brain axis: Regulation by the microbiome. Neurobiol Stress. 2017 Dec;7:124–36. DOI: 10.1016/j.ynstr.2017.03.001. PMID: 29276734. PMCID: PMC5736941.
  29. Pellissier S, Bonaz B. The place of stress and emotions in the irritable bowel syndrome. Vitam Horm. 2017;103:327–54. DOI: 10.1016/bs.vh.2016.09.005. PMID: 28061975.
  30. Livovsky DM, Barber C, Barba E, Accarino A, Azpiroz F. Abdominothoracic postural tone influences the sensations induced by meal ingestion. Nutrients. 2021 Feb 18;13(2). DOI: 10.3390/nu13020658. PMID: 33670508. PMCID: PMC7922384.
  31. Abraham S, Luscombe GM, Kellow JE. Pelvic floor dysfunction predicts abdominal bloating and distension in eating disorder patients. Scand J Gastroenterol. 2012 Jun;47(6):625–31. DOI: 10.3109/00365521.2012.661762. PMID: 22486766.
  32. Iovino P, Neri MC, D’Alba L, Santonicola A, Chiarioni G. Pelvic floor biofeedback is an effective treatment for severe bloating in disorders of gut-brain interaction with outlet dysfunction. Neurogastroenterol Motil. 2022 May;34(5):e14264. DOI: 10.1111/nmo.14264. PMID: 34532928.
  33. Grimes WR, Stratton M. Pelvic Floor Dysfunction. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 32644672.
  34. Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016 Apr;55(3):897–906. DOI: 10.1007/s00394-015-0922-1. PMID: 25982757.
  35. Schumann D, Klose P, Lauche R, Dobos G, Langhorst J, Cramer H. Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Nutrition. 2018 Jan;45:24–31. DOI: 10.1016/j.nut.2017.07.004. PMID: 29129233.
  36. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9). DOI: 10.3390/nu9090940. PMID: 28846594. PMCID: PMC5622700.
  37. Varjú P, Farkas N, Hegyi P, Garami A, Szabó I, Illés A, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies. PLoS ONE. 2017 Aug 14;12(8):e0182942. DOI: 10.1371/journal.pone.0182942. PMID: 28806407. PMCID: PMC5555627.
  38. Maagaard L, Ankersen DV, Végh Z, Burisch J, Jensen L, Pedersen N, et al. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World J Gastroenterol. 2016 Apr 21;22(15):4009–19. DOI: 10.3748/wjg.v22.i15.4009. PMID: 27099444. PMCID: PMC4823251.
  39. Dumitrascu DL, Baban A, Bancila I, Barboi O, Bataga S, Chira A, et al. Romanian guidelines for nonpharmacological therapy of IBS. J Gastrointestin Liver Dis. 2021 Jun 18;30(2):291–306. DOI: 10.15403/jgld-3581. PMID: 33951120.
  40. Heiman ML, Greenway FL. A healthy gastrointestinal microbiome is dependent on dietary diversity. Mol Metab. 2016 May;5(5):317–20. DOI: 10.1016/j.molmet.2016.02.005. PMID: 27110483. PMCID: PMC4837298.
  41. Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Dig Dis Sci. 2004 Jan;49(1):73–7. DOI: 10.1023/b:ddas.0000011605.43979.e1. PMID: 14992438.
  42. Hansen LBS, Roager HM, Søndertoft NB, Gøbel RJ, Kristensen M, Vallès-Colomer M, et al. A low-gluten diet induces changes in the intestinal microbiome of healthy Danish adults. Nat Commun. 2018 Nov 13;9(1):4630. DOI: 10.1038/s41467-018-07019-x. PMID: 30425247. PMCID: PMC6234216.
  43. Kanazawa M, Fukudo S. Effects of fasting therapy on irritable bowel syndrome. Int J Behav Med. 2006;13(3):214–20. DOI: 10.1207/s15327558ijbm1303_4. PMID: 17078771.
  44. El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). Int J Mol Med. 2017 Sep;40(3):607–13. DOI: 10.3892/ijmm.2017.3072. PMID: 28731144. PMCID: PMC5548066.
  45. Spagnuolo R, Cosco C, Mancina RM, Ruggiero G, Garieri P, Cosco V, et al. Beta-glucan, inositol and digestive enzymes improve quality of life of patients with inflammatory bowel disease and irritable bowel syndrome. Eur Rev Med Pharmacol Sci. 2017 Jun;21(2 Suppl):102–7. PMID: 28724171.
  46. Ciacci C, Franceschi F, Purchiaroni F, Capone P, Buccelletti F, Iacomini P, et al. Effect of beta-glucan, inositol and digestive enzymes in GI symptoms of patients with IBS. Eur Rev Med Pharmacol Sci. 2011 Jun;15(6):637–43. PMID: 21796867.
  47. Di Nardo G, Oliva S, Ferrari F, Mallardo S, Barbara G, Cremon C, et al. Efficacy and tolerability of α-galactosidase in treating gas-related symptoms in children: a randomized, double-blind, placebo controlled trial. BMC Gastroenterol. 2013 Sep 24;13:142. DOI: 10.1186/1471-230X-13-142. PMID: 24063420. PMCID: PMC3849317.
  48. Tuck CJ, Taylor KM, Gibson PR, Barrett JS, Muir JG. Increasing Symptoms in Irritable Bowel Symptoms With Ingestion of Galacto-Oligosaccharides Are Mitigated by α-Galactosidase Treatment. Am J Gastroenterol. 2018 Jan;113(1):124–34. DOI: 10.1038/ajg.2017.245. PMID: 28809383.
  49. Camilleri M, Ford AC. Pharmacotherapy for irritable bowel syndrome. J Clin Med. 2017 Oct 27;6(11). DOI: 10.3390/jcm6110101. PMID: 29077050. PMCID: PMC5704118.
  50. Hawrelak JA, Wohlmuth H, Pattinson M, Myers SP, Goldenberg JZ, Harnett J, et al. Western herbal medicines in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Complement Ther Med. 2020 Jan;48:102233. DOI: 10.1016/j.ctim.2019.102233. PMID: 31987249.
  51. Tan N, Gwee KA, Tack J, Zhang M, Li Y, Chen M, et al. Herbal medicine in the treatment of functional gastrointestinal disorders: A systematic review with meta-analysis. J Gastroenterol Hepatol. 2020 Apr;35(4):544–56. DOI: 10.1111/jgh.14905. PMID: 31674057.
  52. Black CJ, Yuan Y, Selinger CP, Camilleri M, Quigley EMM, Moayyedi P, et al. Efficacy of soluble fibre, antispasmodic drugs, and gut-brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(2):117–31. DOI: 10.1016/S2468-1253(19)30324-3. PMID: 31859183.
  53. Mosaffa-Jahromi M, Lankarani KB, Pasalar M, Afsharypuor S, Tamaddon A-M. Efficacy and safety of enteric coated capsules of anise oil to treat irritable bowel syndrome. J Ethnopharmacol. 2016 Dec 24;194:937–46. DOI: 10.1016/j.jep.2016.10.083. PMID: 27815079.
  54. Munjal A, Dedania B, Cash BD. Current and emerging pharmacological approaches for treating diarrhea-predominant irritable bowel syndrome. Expert Opin Pharmacother. 2020 Jan;21(1):63–71. DOI: 10.1080/14656566.2019.1691524. PMID: 31738621.
  55. Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014 Jul;48(6):505–12. DOI: 10.1097/MCG.0b013e3182a88357. PMID: 24100754.
  56. Menees SB, Maneerattannaporn M, Kim HM, Chey WD. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2012 Jan;107(1):28–35; quiz 36. DOI: 10.1038/ajg.2011.355. PMID: 22045120.
  57. Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011 Jan 6;364(1):22–32. DOI: 10.1056/NEJMoa1004409. PMID: 21208106.
  58. Lembo A, Zakko SF, Ferreira NL, Ringel Y., Bortey E, Courtney K, et al. T1390 Rifaximin for the Treatment of Diarrhea-Associated Irritable Bowel Syndrome: Short Term Treatment Leading to Long Term Sustained Response. Gastroenterology. 2008 Apr;134(4):A-545. DOI: 10.1016/S0016-5085(08)62544-5.
  59. Ghoshal UC. Antibiotic treatment for small intestinal bacterial overgrowth: Is a cocktail better than a single? United European Gastroenterol J. 2021 Jul;9(6):643–4. DOI: 10.1002/ueg2.12075. PMID: 33951351. PMCID: PMC8280792.
  60. Mahboubi M. Therapeutic Potential of Zataria multiflora Boiss in Treatment of Irritable Bowel Syndrome (IBS). J Diet Suppl. 2019;16(1):119–28. DOI: 10.1080/19390211.2017.1409852. PMID: 29333891.
  61. Ford AC, Lacy BE, Harris LA, Quigley EMM, Moayyedi P. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019 Jan;114(1):21–39. DOI: 10.1038/s41395-018-0222-5. PMID: 30177784.
  62. Black CJ, Thakur ER, Houghton LA, Quigley EMM, Moayyedi P, Ford AC. Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2020 Aug;69(8):1441–51. DOI: 10.1136/gutjnl-2020-321191. PMID: 32276950.
  63. Ford AC, Quigley EMM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2014 Sep;109(9):1350–65; quiz 1366. DOI: 10.1038/ajg.2014.148. PMID: 24935275.
  64. Hasan SS, Whorwell PJ, Miller V, Morris J, Vasant DH. Six vs 12 Sessions of Gut-focused Hypnotherapy for Irritable Bowel Syndrome: A Randomized Trial. Gastroenterology. 2021 Jun;160(7):2605-2607.e3. DOI: 10.1053/j.gastro.2021.02.058. PMID: 33662389. PMCID: PMC8202328.
  65. Flik CE, Laan W, Zuithoff NPA, van Rood YR, Smout AJPM, Weusten BLAM, et al. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2019 Jan;4(1):20–31. DOI: 10.1016/S2468-1253(18)30310-8. PMID: 30473202.
  66. Scaciota ACL, Matos D, Rosa MMB, Colovati MES, Bellotto EFBC, Martimbianco ALC. Interventions for the treatment of irritable bowel syndrome: a review of cochrane systematic reviews. Arq Gastroenterol. 2021;58(1):120–6. DOI: 10.1590/S0004-2803.202100000-20. PMID: 33909790.
  67. Lackner JM, Jaccard J, Keefer L, Brenner DM, Firth RS, Gudleski GD, et al. Improvement in gastrointestinal symptoms after cognitive behavior therapy for refractory irritable bowel syndrome. Gastroenterology. 2018 Jul;155(1):47–57. DOI: 10.1053/j.gastro.2018.03.063. PMID: 29702118. PMCID: PMC6035059.
  68. Windgassen S, Moss-Morris R, Chilcot J, Sibelli A, Goldsmith K, Chalder T. The journey between brain and gut: A systematic review of psychological mechanisms of treatment effect in irritable bowel syndrome. Br J Health Psychol. 2017 Nov;22(4):701–36. DOI: 10.1111/bjhp.12250. PMID: 28573818.
  69. Thakur ER, Shapiro J, Chan J, Lumley MA, Cully JA, Bradford A, et al. A systematic review of the effectiveness of psychological treatments for IBS in gastroenterology settings: promising but in need of further study. Dig Dis Sci. 2018 Sep;63(9):2189–201. DOI: 10.1007/s10620-018-5095-3. PMID: 29744772.
  70. Holmes HJ, Thakur ER, Carty JN, Ziadni MS, Doherty HK, Lockhart NA, et al. Ambivalence over emotional expression and perceived social constraints as moderators of relaxation training and emotional awareness and expression training for irritable bowel syndrome. Gen Hosp Psychiatry. 2018 May 3;53:38–43. DOI: 10.1016/j.genhosppsych.2018.05.002. PMID: 29751205. PMCID: PMC6086751.
  71. Zernicke KA, Campbell TS, Blustein PK, Fung TS, Johnson JA, Bacon SL, et al. Mindfulness-based stress reduction for the treatment of irritable bowel syndrome symptoms: a randomized wait-list controlled trial. Int J Behav Med. 2013 Sep;20(3):385–96. DOI: 10.1007/s12529-012-9241-6. PMID: 22618308.
  72. Naliboff BD, Smith SR, Serpa JG, Laird KT, Stains J, Connolly LS, et al. Mindfulness-based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness. Neurogastroenterol Motil. 2020 Sep;32(9):e13828. DOI: 10.1111/nmo.13828. PMID: 32266762.
  73. Kuo B, Bhasin M, Jacquart J, Scult MA, Slipp L, Riklin EIK, et al. Genomic and clinical effects associated with a relaxation response mind-body intervention in patients with irritable bowel syndrome and inflammatory bowel disease. PLoS ONE. 2015 Apr 30;10(4):e0123861. DOI: 10.1371/journal.pone.0123861. PMID: 25927528. PMCID: PMC4415769.
  74. Schumann D, Anheyer D, Lauche R, Dobos G, Langhorst J, Cramer H. Effect of yoga in the therapy of irritable bowel syndrome: a systematic review. Clin Gastroenterol Hepatol. 2016 Dec;14(12):1720–31. DOI: 10.1016/j.cgh.2016.04.026. PMID: 27112106.
  75. Hosseini-Asl MK, Taherifard E, Mousavi MR. The effect of a short-term physical activity after meals on gastrointestinal symptoms in individuals with functional abdominal bloating: a randomized clinical trial. Gastroenterol Hepatol Bed Bench. 2021;14(1):59–66. PMID: 33868611. PMCID: PMC8035544.
  76. Goldenberg JZ, Brignall M, Hamilton M, Beardsley J, Lichtenstein B. Biofeedback for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2017 Jan 26; DOI: 10.1002/14651858.CD012530. PMID: 31713856. PMCID: PMC6848969.
  77. Barba E, Burri E, Accarino A, Cisternas D, Quiroga S, Monclus E, et al. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology. 2015 Apr;148(4):732–9. DOI: 10.1053/j.gastro.2014.12.006. PMID: 25500424.
  78. Lacy BE, Cangemi D, Vazquez-Roque M. Management of chronic abdominal distension and bloating. Clin Gastroenterol Hepatol. 2021 Feb;19(2):219-231.e1. DOI: 10.1016/j.cgh.2020.03.056. PMID: 32246999.
  79. Zhou S-Y, Gillilland M, Wu X, Leelasinjaroen P, Zhang G, Zhou H, et al. FODMAP diet modulates visceral nociception by lipopolysaccharide-mediated intestinal inflammation and barrier dysfunction. J Clin Invest. 2018 Jan 2;128(1):267–80. DOI: 10.1172/JCI92390. PMID: 29202473. PMCID: PMC5749529.
➕ Links & Resources

Further Reading: 

Need help or would like to learn more?
View Dr. Ruscio’s, DC additional resources

Get Help

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

Transform your health

Every product is science-based, validated by real-world use, and personally vetted by Dr. Ruscio, DC.

Shop Now